The Clinic RN Referral Coordinator collaborates with the health care team to develop theory-based patient care for patients undergoing complex care and surveillance. Reviews patient records, interviews patients, refers patients for initial visit and documents/creates abstracts in EMR for incoming referrals. Responsible for patient, significant other, and nursing staff education regarding complex disease management. Responsible for performing job duties in accordance with the mission, vision and values of Tampa General Hospital (TGH) and University of South Florida Tampa General Physicians (USFTGP). Essential Functions Reviews patient medical history, physical conditions, medical diagnosis, available treatment options, financial resources and physician orders, comparing care plan to make necessary revisions. Patient intake, evaluation and referral; screens, monitors and documents patient progress, requesting images, records, and ordering any additional, required pre-operative labs or imaging to facilitate clinic visit. Completes frailty screening for patients and initiates risk assessment chart in preparation for patient to be seen in clinic. Determines appropriate course-of-treatment and develops and implements individualized care plans. Maintains surveillance program and ensures necessary adjustments to care plans, along with educating patients and their families on wound care best practices. Refers patient to appropriate ambulatory, hospital, and community resources. Provides accurate and consistent documentation of services including assessment, care plans, education and reassessment, and involvement with physicians. Collaborates with Social Work to manage the needs of patients who have high acuity psychosocial needs coupled with need for medical care to mitigate risk for hospital admission/readmission. Works in partnership with physicians to consider alternate levels of care if patient is not meeting clinical stability.
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Job Type
Full-time